And How to Find the Right Rehab, if it is Necessary

By Julie Myers, PsyD, MSCP

It is my opinion that most people with substance abuse or dependency issues can recover with outpatient treatment from a licensed mental health professional or with the support of self-help groups. However, in some cases, a Residential Treatment Center (RTC) may be necessary.

A licensed mental health professional, such as a psychologist certified in addiction treatment, can formulate an individualized treatment program equal to or better than many programs offered by “rehabs”. A psychologist can provide individualized care to help identify behaviors and emotions that drive substance-using behaviors and can treat any underlying mental health conditions that likely exist. Competent professionals can formulate an integrated, comprehensive program, which can include psychotherapy and referrals to psychiatric care, self-help meetings, group therapy, sober living homes, and other alternative treatments modalities. The notion that everyone with substance abuse problems needs residential treatment is as unreasonable as stating that everyone with depression needs hospitalization.

Although outpatient treatment is preferable and sufficient for most people, there are those who may need a higher-level of care than outpatient treatment can provide. In particular, some people may need a more restrictive environment, where there is no access to drugs or alcohol. Sometimes, when a person is actively using and can’t stop, a Residential Treatment Center can provide the respite that a person needs from their access to drugs or alcohol. They may also be indicated for those with severe forms of co-occurring psychiatric disorders that have not been adequately stabilized.

However, RTCs can vary greatly in their quality and level of care. Some offer comprehensive, “gold standard” care, with evidence-based practice from qualified treatment professionals. Others may offer little more than restrictive use of substances. So the question becomes, how does one choose a Residential Treatment Center? It may be difficult to determine which is the best RTC for themselves or their loved-ones, because they may not know the right questions to ask, and because many RTCs may be vague about what their programs include.

It would be helpful to have a set of key questions that someone seeking treatment could ask of the RTC about their program. Recently, Dr. Donald Meichenbaum shared a letter with me, which he drafted for those seeking residential care. This letter can be sent to the Director of an RTC that a person is considering. This letter asks questions about the RTC’s program, questions that can help the consumer make an informed decision about that facility. I have reposted his letter on my website, which you can find at http://www.DrJulieMyers.com. I believe that this letter can help guide the consumer to find a residential treatment center that is right for them, should they need that level of care.

A Roadmap to Resilience and Recovery

by Julie Myers, PsyD, MSCP

Recovery from substance abuse is a process unique to each individual. Despite those who believe otherwise, there is no single “right” path to recovery. Instead, each person has a unique set of challenges and must address those challenges uniquely. This is not to say that there are not techniques, tools, or methods that have been shown to be helpful in substance abuse treatment, but rather that because no one person’s history is exactly the same, no recovery will be exactly the same. Each individual must find their own path.

However, finding that unique path can be overwhelming, particularly because of the amount of information available, from differing sources and viewpoints. This can leave an individual confused and sometimes fearful about which path is best for them. Sometimes, friends or family members, therapists, or self-help groups can help guide the individual. But sometimes, what really is needed is simply a roadmap, outlining the options available to an individual in different domains. Donald Meichenbaum has written such a roadmap.

Although not intended solely for those in recovery, Meichenbaum’s book, Roadmap to Resilience* remarkably address many of the key aspects that form the foundation of most recovery programs, addiction or otherwise. His book is an easy-to-use, comprehensive resource packed with practical coping strategies, action plans, checklists, and thought-provoking inspiring quotations from those who have experienced adversity, even encouraging readers to submit their own experiences to the book’s website. Dr. Meichenbaum gifts the reader with his 40 years of expert clinical experience and wisdom, all in one handy resource.

Roadmap to Resilience is organized by six domains: Physical, interpersonal, emotional, cognitive, behavioral, and spiritual resiliency. Resiliency — “the capacity to adapt successfully in the presence of risk and adversity” — is at the core of addiction recovery. Although the book’s target audience are those who have suffered trauma, the process of recovery requires similar attention to these six domains. If resiliency is the ability of an individual to adjust to change and transform their lives, then almost anyone who has recovered from substance abuse has in some way been resilient.

This book is indeed a “roadmap”, rather than a directive. It offers the reader a broad depiction of the choices available for recovery, but with enough detail to navigate and put into practice specific tools. I would strongly recommend this book not only to anyone beginning their journey of recovery, but to anyone who wishes to bolster and improve their ability to successfully navigate their world.

*Meichenbaum, Donald (2012) . “Roadmap to Resilience: A Guide for Military, Trauma Victims and Their Families”, Institute Press, 211 pp. Readers of Meichenbaum’s book can submit examples of resilience-engendering behaviors to the book’s Website at www.roadmaptoresilience.org. (See “Ideas for Resilience” and “Examples of True Grit” to read about stories of recovery.) Dr Meichenbaum is one of the founders of Cogntivie Behavior Therapy and is presently Research Director of the Melissa Institute for Violence Prevention in Miami ( www.melissainstitute.org).

How decision fatigue can affect your recovery

by Julie Myers, PsyD, MSCP

Licensed Clinical Psychologist in San Diego

Recent research on the topic of willpower shows that we, as human beings, have limited decision making capacity. That is, in any given day, we may simply run-out of the mental energy that is required to make decisions. Researcher Roy Baumeister, PhD calls this depletion of mental energy “decision fatigue.”

Every day, we make hundreds of decisions, from large to small. Even something as simple as eating breakfast may entail many decisions, such as what, where, and how much to eat. We need to make decisions about our personal selves, our work, our relationships, how we move about and relate in the world, and how to resist a temptation. The more decisions we must make, the more mental energy we use up. Making decisions, particularly making good decisions, becomes harder over the course of a day as our mental energy wanes.

So why is this important for recovery from substance abuse? Because the choice to not use is a decision. Much of drinking/using is automatic, that is, we use simply because it is our habit to do so. We step into the house after a long day, we have a drink or we get together with friends, we smoke a joint. It may cross our minds not to use, but to not use requires a decision. To say no, we must think about the consequences. When our mental energy is low, we tend to act impulsively or do nothing different than usual.

We need to give ourselves the best chance at making good decisions, particularly when we are trying to change our relationship with drugs or alcohol. Baumeister has shown that people with the best self-control set themselves up for success by conserving their mental energy. For example, they may arise at the same time daily, eat the same breakfast, eliminate temptations, and delegate authority. They don’t expend their mental energy on trivial decisions, instead preserving their mental energy for making important decisions.

If you want to give yourself the best chance of saying no to addictive substances or behaviors, here are eight simple tips to conserve mental energy for decision making success:

1. Turn-on your brain.
Become more aware of when and where you are most vulnerable to automatic use or when decisions are needed.

2. Restore your mental energy with good sleep.
Make your important decision in the morning, when your mental energy is at its peak.

4.Employ relaxation strategies.A calm state increases our decision making capacity. Relaxation techniques, such as slow breathing or meditation, will help to decrease the stress response.

5. Conserve your mental energy.
Decrease the number of decisions you must make in a day by creating healthy habits. Delegate some decision to trusted others. Reduce situations where you need to make decisions, such as shopping.

6.Reduce temptationsMove temptations out of your reach, when you have the mental energy to do so.

7. Recharge your mental energy throughout the day.
Exercise has been shown to increase mental energy. Exercise regularly, on a set schedule. Even 5 minutes of daily exercise will help recharge your mental energy.

7. Reduce the number of times that you need to say no.
By planning ahead, you can avoid those situations in which your habit to use requires mental energy to say no. If you know when you are most vulnerable and plan ahead, you will need to make fewer decisions about whether or not to use.

By employing the strategies above, you will give yourself a better chance for recovery success by reducing your decisions fatigue.

If you would like to read more about this topic here are two books you might enjoy

Stopping a slip from becoming a relapse

by Julie Myers, PsyD, MSCP

For many with serious substance abuse problems, any drug or alcohol use can be problematic. These people must abstain. If they drink or drug again, they can slip into full-blown relapse, even after months or years of abstinence. For some, even a brief lapse may generate so much self-doubt, guilt, and a belief about personal failure, that the person gives up and continues to use. This tendency is referred to as the abstinence violation effect.

So does this mean that even a brief lapse must lead to a full-blown relapse? Does it mean a person must continue to drink or drug until the use returns to the initial level? Is spiraling out of control inevitable? Simply put, no. A lapse need not become a relapse. After a slip, you have not unlearned all that you have learned. You have not unchanged all that you have changed in your life to support your recovery. You do not have to start counting again from day one.

If you view your lapse as a mistake and as a product of external triggers, rather than as a personal failure, research shows that you will have a much better chance of return to abstinence quickly. Your lapse becomes a tool to move forward and to strengthen your motivation to change, your identification of triggers and urge-controlling techniques, your rational coping skills, and the lifestyle changes needed to lead a more balanced life.

Does this mean that a person should view these lapses as a good thing? Of course not! Clearly, if one wants to abstain, lapses are not preferred. But by recognizing that mistakes can happen and learning how to quickly right oneself, long-term abstinence can be achieved. Lapses may occur, but relapse is not inevitable.

OK, I quit using. So why don’t I feel happy?

by Julie Myers, PsyD, MSCP

It’s not difficult to understand why someone, who is actively using drugs, may feel bored when he/she is not high. It is more difficult to understand why that person may continue to have difficulty enjoying activities once the drug is stopped. But this is not uncommon. People who quit using drugs often report that they are bored, uninspired, and have a hard time enjoying everyday living. Why does this happen? It has to do with the brain chemical (neurotransmitter) called dopamine.

We are programmed from birth to seek pleasure, and when dopamine is released into the brain, we experience it as pleasure. Pleasurable activities release dopamine into the brain, and our choice to engage in activities often has a direct relationship to the amount of dopamine released.

Drugs of abuse release rapid and large amounts of dopamine directly into the brain. In essence, they hijack the normal pleasure/reward pathway of the brain, directly stimulating it with readily available dopamine. Such a massive and easily obtained source of dopamine dwarfs our ability to obtain dopamine from smaller, but more sustainable sources, such as what we would get from reading a good book, taking a walk with friends, or reaching a goal at work.

When the memory of drugs is strong, it may be difficult to find pleasure in everyday activities. The memory of how drugs activate the reward center remains even after an individual stops using the drug. With time, and as one begins to engage in everyday activities, the memory of the drug as a ready source of dopamine fades, and simple activities take on more meaning and pleasure. The brain relearns ways to obtain pleasure from smaller, more sustainable sources of dopamine.

Does this mean that someone must simply wait for the brain to reprogram itself? No! You can change your brain! As with any learning, the more you practice, the faster the skill is learned. You may have to push yourself, engaging in pleasurable everyday activities. You won’t feel a huge surge of dopamine like you used to with drugs, but you will obtain some pleasure and you will be retraining your brain. So try to remember some of the activities you used to do before you started using drugs, imagine yourself doing these things, and do them now. Start getting engaged with life and find meaningful and enduring satisfactions that will reward your brain. It’s up to you!

Taking Control of Cravings

by Julie Myers, PsyD, MSCP

Cravings for drugs or alcohol are controlled by a variety of brain chemicals, including norepinephrine, dopamine, and glutamate. Many people describe their cravings as coming out of nowhere, as if these chemicals pop into their brains and create a cravings spontaneously.

These chemicals and the manifestations of cravings are actually triggered by stimuli from external environmental cues and internal mood states, particularly anxiety, irritability, and dysphoria. Environmental cues can include familiar people, places or things, for e.g., being in a favorite place that you used to use. Environmental triggers are often easier to identify than internal mood states, particularly if the moods are subtle. For example, a mildly irritating discussion may be enough to trigger a craving, although it may be difficult to identify this discussion as the trigger.

So does this mean that you are at the mercy of the environment and your own internal mood states? Absolutely not! It means that you can minimize your cravings by employing ways to control your environment and modify your mood. You have the power to choose what people, places and things you expose yourself to that might trigger a cravings. You also have the power to recognize and change your own reactions, thereby changing your mood state.

The first step is to identify your specific triggers. Try keeping a simple log of your cravings. What environmental cue did you encounter? What were you feeling? Sit down and write it down. Think about it backwards, from the time that the craving hit, backwards until you can identify something you believe triggered that craving.

If you can identify your triggers, you have taken the first step to taking control of your cravings.

Journaling to Take Control of Your Thoughts

by Julie Myers, PsyD, MSCP

Some people enjoy writing down their thoughts in a diary or journal. This can be cathartic, helping a person feel less alone. It may be a wonderful way to express gratitude, love, or to get perspective on one’s life. However, sometimes writing down negative or irrational beliefs can reinforce and strengthen the belief. When the negative thought is there on the paper, in black & white, it may give it more validity and power.

If you find yourself feeling better after you write your thoughts down, you are probably using a good strategy. But, if you feel worse or no better, try this strategy:

Write down your thoughts.

Next, assess how you feel. Do you feel angry, sad, or just plain miserable?

If you are experiencing a negative emotional reaction, stand back and review the thoughts you just wrote down. Are you using self-defeating beliefs that are illogical, unhelpful, or just plain untrue? Ask yourself if you are using absolute and literal demands, such as “musts”, “should” and exaggerated needs. Are there common thinking errors in your statements, such as blaming, catastrophizing, or rationalization?

Just below your written thoughts, dispute or rewrite your original thoughts (beliefs). Do these make more sense? Are they more logical?

Now, assess how you feel again. Did disputing the original thoughts improve your mood? If so, your journaling is helping you to gain control over your thoughts, emotions, and behaviors.